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Thursday, September 25, 2014

We are the student health doctors and as such, we've had some emails this week about a controversial topic: HPV (human palliomavirus) vaccines for early adolescents. In Pediatrics they are considered routine adolescent anti-cancer vaccines (virtually all cervical cancers are caused by HPV). For once there is a cancer that is completely preventable if a person is never infected with the HPV virus. The rub comes when parents with very strong Christian beliefs assume that their child will never be infected, because he/she will never have a sexual encounter until their wedding day, and will marry someone who also remained celibate until that moment. I fully believe that is healthy, and best. And possible.

But far from a guarantee. We live in a broken world. Even Adam and Eve, who were created perfect and then parented directly by God and had daily intimate communication with Him, succumbed to the temptation to do the one thing they were forbidden. Christians sin. All of us. Pride, gossip, laziness, cruelty. And sometimes, being led away by passion to make a physical commitment beyond readiness for a full-life commitment. There will be consequences emotionally and physically. There will be grace, and healing. But I would hope that if we could prevent one consequence, that of death by cancer in one's 30's, by a simple vaccine, we would do that.

Secondly, the broken world means that even if a particular kid is faithful and abstinent, she may be harmed by the sin of another. Nice girls can be naive. They can have something like valium slipped in a drink. They can wake up to find themselves raped. More than half of young adults in past decades ended up infected with HPV, so chances are pretty high that a rapist would transmit the disease. Again, there is grace and healing, but in this situation we'd all opt for preventing AIDS or cancer if we could, wouldn't we?

Thirdly, even if the child walks down the wedding aisle having made perfect choices, and having been protected from all harm, there is a good chance his/her spouse will not have had the same advantages. Some wonderful people become Christians later, after having made choices that left them with scars. There is such beauty in that. In fact the whole book of Hosea is about God asking one of His servants to marry, love, protect, redeem a former prostitute. When your kid is 12, you have no idea what path God has for him/her in the decades to come. We are surrounded by a world where the Fall means that disease and death abound.

In this context I read with my team yesterday the story of Hagar and Ishmael. Remember her weeping in the desert, thinking her son was going to die? There she was, at the end of her resources, facing the worst thing imaginable for any of us as parents. Helpless. And what put her there was a mixture of her own choices (taunting Sarah), the sin of others against her (she didn't exactly choose to be a bondservant most likely, and having Abram's baby may not have been her choice either, let alone being sent into the desert), and the general brokeness of a world of deserts without water, of distance, heat, and exhaustion. Yet at that moment, God hears, sees, comes. He provides. He rescues. Even if she sinned and others sinned and the world is a mess, He still saves the boy from some of the consequences. He does not add up and inflict upon us exactly what we deserve. Because the deepest part of God's nature is love. For us and for our children. I find this extremely encouraging, that if God hears the prayerless despair of a foreign servant friendless and alone in the desert, He also knows how to provide for us and our children.

So, parents, I am opting for vaccination. I truly hope none of my children need that extra margin of protection. I hope they experience only true, faithful, exclusive love in their lives, and so do their spouses. But if they, like Hagar and Ishmael, find themselves beat up by this world through their own choices, or the choices of others, I have the small comfort that cancer may not be one of the dozens of things that need healing. And the large comfort that NOTHING can separate them from the God-who-sees. That Love is suffusing the hot desert winds, and will provide and oasis.

Sunday, September 14, 2014

Friday night lacked subtlety. Evil overplayed its hand. In the disturbing trauma of the grabbing shadow violating my lap, the helpless confusion, the jumpy gang, Scott running . . . we called on the name of Jesus when there was nothing else to do. We were up against darkness but also unwise in our decisions. So many people have been kind and supportive, my sense is that the whole over-the-top nature of the situation has backfired into victory.

Most of life, the struggle is way more subtle. Insidious loss or eroding frustrations are much harder to name, to share, to rally against.

Pictured above is R, whose husband gave her HIV then disappeared. She came to our hospital 3/4 of the way through her 5th pregnancy. All four previous babies had died, either as stillbirths or within hours of delivery. She is diabetic, malnourished, and depressed. With vacant eyes she let her sister do the talking. Her amniotic fluid was increasing dangerously fast; her baby had slowed in his movements, and even though she was very premature the OB team felt she had to be delivered. We felt the chances of her baby's survival were already low and falling by the day. So to the theatre she went. And out came a plethoric, bloated, but crying baby boy. He's breathing well, a bit jaundiced, and it is taking time for his blood sugar to stabilize. But all in all we are very hopeful that R may at last take home a live child.

This battlefront is every bit as important as thieves in the darkness, but the life-threat is to a nameless infant and much harder to see.

R smiled when I greeted her today. She has recovered something precious, hope. And she welcomes your prayers for her and her child, who still face weeks of intensive care and years of struggle. For the little boy to survive, his mother needs the kind of care that can hold her virus at bay. A more insidious evil means she's a functional widow, and is eking by on first-level anti-retro-virals with a poor response. She is determined to feed her baby formula to lessen his risk of AIDS, but that may mean great sacrifice for her. Yet today she is courageous and full of plans, as she looks at a breathing child of her own who has lasted four days for the first time.

This is only one story in dozens already, as we move through day 5 back in Kijabe. More subtle lines between good and evil, life and death:

Surprise twins, when we thought we were getting only one preemie, they turned out to be a matching brother/sister pair.

This is not normal. A baby born in Dadaab refugee camp, within 36 hours is noted to have a massively swollen abdomen from blocked intestines, and makes the arduous trip to Nairobi to see our surgeons. Because this church hospital is the preferred center of healthcare for an entire nationality and people-language-group to our northeast, even though Kenya is at war with them, even though we're smack dab between the anniversary of 9-11 and Westgate, this little girl will have her life-saving procedure tomorrow. And probably neither she nor her family will be recruitable to the kind of terrorist cell that Uganda is trying to thwart this weekend.

This, below, is just plain sweet perfection in a tiny package. Her mother suffers from severe pre-ecclampsia and risked dying unless she was delivered today; and she probably would not have made it much longer in that hostile inadequate environment either. But there she is, pink and relaxed, about thirty minutes old.

And just to keep things interesting, we landed back into a weekend on call and the first Caring Community (families have a small group of dorm kids over monthly) . . . .

. . . and our first-ever Senior Boys' Sunday School.

Between the two we have the opportunity to support, feed, love, encourage, and point to Jesus a bunch of great guys from Africa, Europe, Asia, and North America. Like most high school seniors they are concerned about college apps, sports injuries, and time management. But they also ask prayer for elections in their unstable countries, parents who are working in dangerous places, wilderness flights and Bible translations.

And lastly, a shout-out to friendship and teamwork. Because the subtle borders of the Kingdom struggle demand reinforcements. One of the greatest surprises of this return was the quick embrace of friendship. We have a Serge team here now where we came almost 4 years ago alone. We have meals and walks and prayer and concern. Karen, Bethany, and Ann to the rescue. And this month, we have Carol. Carol L grew up in the same church I did (though decades later). Her parents are our friends and supporters. Once upon a time she came to Bundi as an intern and got talked into staying half the year. Now she's in her third year of a Med-Peds residency, and brought her calm laugh, good sense, quiet can-do, smart competence right into our lives again. She's staying with us and working with me, which is why I can be typing this on a Sunday evening on-call.

I hope that as many readers who were caught up in the drama of highway robbery will also see the more subtle moments of goodness, sacrifice, and hope in the stories of the weekend. Moms who get years to love, boys who want to use their strength for service, babies who can breathe and grow. Evil losing its grip on iPhones and on lives.

Friday, September 12, 2014

Some dear friends of our had a no-good, horrible, very-bad day. Our team leaders from Burundi were flown by air ambulance from Bujumbura because a chronic disc problem in the wife's back took an acute turn for the worse. She was unable to sit or walk and in constant pain. Surgery that they had tried to avoid is now necessary. They spent the night arranging the flight and the day getting here to Nairobi where they had a contact with a neurosurgeon at one of the two private hospitals in town. A hospital that most westerners would actually recognize as such: clean halls, spacious, lighting, curtains, wheeled gurneys that don't look like museum relics, abundance of staff, no visible blood or grunge. By the time we got off work and went to meet them they had been settled in a small cubicle for a couple of hours waiting for a doctor to come. We had a good visit, used our Kenyan cell phones and email, made calls to our office in America and the insurance company, interacted with the staff, prayed, and just generally tried to keep them company and help move the glacial admission process forward. It was good to be with them and try to be helpful. By a bit after 9 pm they encouraged us to go home, knowing we would arrive quite late already. They were scheduled for an MRI in the morning, and hopefully surgery to follow. Please pray for a safe and successful procedure.

That's when our no-good very-bad night really kicked in. On our rather fast and surprisingly low-traffic ride into town we had abandoned plans to buy groceries or dinner because there was a huge jam around the shopping area, and we wanted to get there. We had missed lunch and dinner and we asked the guard at the hospital if we could find something at 9 pm, He directed us down the hill, where we could see a sign for a restaurant. We turned onto another road and looked for parking. Dark. No street lights. No cars. The parking lot locked. Confused we came to the end of the street and saw that there was a narrow curved connection to the main road that was clearly designed to bring traffic off the main road in the opposite direction, so we stopped. Out of the darkness THREE police appeared, and demanded to see Scott's license. You have committed a crime, they said. This is one-way and you are driving the wrong way. To make a painful story shorter they were lurking there for the sole purpose of extracting money. There was no signage to indicate one-way, and we never entered the narrow connection, but they said Scott would have to go to the police station right away, pay 20,000 KSH ($250) and then return to court on Monday. Of course they just wanted money. They produced a "boss" who had "authority" to hold court roadside and avoid the hours of delay. I pleaded. They were nice, then not nice, then nice again. We finally settled on 9000 KSH (a little over $100). Feeling discouraged, exhausted, three-days into jet lag, and hours from home, we again abandoned plans to eat and just headed towards Kijabe.

Which was fine for a few miles, except for numerous life-threatening buses running lights and barreling down on us with impunity, and no police in sight except for the ones lazing at round-abouts, stopping traffic at one point for 25 minutes straight while we sat doing nothing. Oh well. The night was about to get much worse. As we headed up out of town the same traffic snarl we had seen coming in was still there, now 4-5 hours later. We stopped. We inched. We crawled. We were actually at a point where we were slowly rolling forward in our two lanes of the 4-lane divided highway when suddenly a dark long shape shot in my window. My window was only down about 3-4 inches and I was texting my kids in America about one of them being sick. I had my iphone held on by lap. It took my brain a second to process what was happening. It was frightening, this arm violating my space, reaching into my lap and grabbing my phone from my hands in a slowly moving car. I screamed, Scott braked, I opened the door and yelled again, he ran between the lanes of cars and disappeared. People stopped, asked what happened, looked sorry, but there was nothing to do. It was pitch dark.

That phone is my connection to my kids. And my number one work tool. Scott pulled over into the median strip and got out of the car to look for the guy, but he was long gone. He got back in and we tried to use his phone to get on the internet and wipe my account clean. Of course, the page wouldn't load. Then we decided to just call the phone and see if the thief was still close by and would sell it back. He answered, Scott pleaded. The thief was worried we were trying to trap him. We offered just over a hundred dollars (again) because the hassle and expense of replacing the phone would be many times worse. He said he'd come back. Scott waited, even crossed the lanes of traffic to look for him on the other side (against my yelled protests). Scott called him again, he kept saying he was coming, giving landmarks of where he was. Then Scott decided to walk back in the direction we'd come from and cross the road again. I could no longer see him. It's after 10 pm, we're in the middle of a busy highway, but the sides are in shadow. I have not been so scared in a long time. In fact I could only pray over and over "Lord Jesus, have mercy. Lord Jesus. Lord Jesus." It was odd, but that's all I could do, over and over and over.

For good reason, because while I was imagining an unstable, maybe violent guy, it was actually much worse. Scott approached the person he saw who turned out to be a bystander, and while he was talking a gang of six men surrounded him. At that moment he knew we had made a huge error in judgement. It's only a phone. Not worth a life. They could have dragged him away from the road and beat him, taken the money and both phones. But God protected him in that helpless situation. He held out the money and talked calmly. The thief held out the phone. They tentatively had their hands on both for a second and then the exchange was done. Scott backed away reassuring them over and over that he was not tricking them. They counted the money and left, and he ran back to the car glad to be alive.

OK if our kids did that I would be so upset at their foolishness. We were not using good judgement. Blame it on jet lag and the late hour. Or on the spiritual darkness of this evening: A seriously ill team leader. A bureaucratic tangle prolonging suffering while the insurance company dragged its feet. Corrupt police. Thieves working with impunity. One guy against a gang.

But for reasons I can't explain, this time God protected us from ourselves.

We are still a bit shaken at midnight, and not looking forward to heading into a 48 hour call in only 7 more hours.

This night reminds me that we need, desperately, our partners in prayer to keep us and our teams in God's hands. The reality of ebola has really hit us being back. The tenuous nature of everything. And the direct confrontation with palpable evil. Thanks for praying.

Tuesday, September 02, 2014

Rainbows require two weather extremes: rain and sun, at the same time. Not a median between them, say cloudy weather with dim sunshine, or a light pleasant mist. Rather both seemingly polar truths held together. In other words, paradox.

Which is how GK Chesterton explains faith, and God. Mercy and Justice, the ultimate depths of each, simultaneously. Sovereignty and Choice. Life and Death. Beauty and Brokenness. We have a human tendency to mute one with the other, to seek a comfortable compromise that keeps our minds from being stretched. But truth requires us to embrace paradox.

This weekend we headed with Caleb out to Breckenridge to spend about 40 hours on the ranch of friends (where I spent 40 days on retreat two years ago). These people are wise and generous and have blessed us with respite and space. Their ranch is a place where spiritual unseen reality breaks through. So when we got on the road in the evening after a full day of Air Force events and passed into rainy weather, it was a little disappointing at first. Then just as the sun was setting Caleb looked back and noticed this rainbow. It was even more spectacular in real life, glorious depth of color and a full double arch. We pulled off the road in awe, whipped by strong wind and bathed in golden light. The next morning we awoke to more rain with a full arch brilliant rainbow outside the window. In spite of rain we hiked all day, with alternating moments of sun and storm, and more rainbow glimpses.

When a pattern repeats, it gets our attention. Rainbows are reminders of hope, of promise. But they are also symbols of paradox. The reason we need the hope is that we are living in the storm that looks like destruction and judgement. There is danger in the post-flood rain, but there is also God's love.

Holding the two truths of difficulty and blessing together is our challenge this season. Two kids are facing the challenge of transition: hard schools, competition, disjointed loneliness, some disappointments. Two others are forging into junior and senior years with responsibility and hard work. Our hearts long to be in all four places. We are heading now into a week of Serge meetings where the frontiers of the restoration are before us. New team leaders head to South Sudan in two days. Ebola is a hovering threat on our continent, and our hearts grieve. But in all of this the rainbow promises that God's love is sure and true. In fact, is the foundational truth, deeper than the storms of sorrow.

Our Mission

who we are

paradox:
1. something that combines contradictory features or qualities.
Life in Africa is full of contradictions - the beauty and pain; the abundance and the poverty; the joy and the sorrow.
Our lives, too...dying that we might live; strong in our weakness; sinners yet saints.
2. a "pair of docs"